References of "Detry, Olivier"
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See detailA multicentre outcome analysis to define global benchmarks for donation after circulatory death liver transplantation.
Schlegel, Andrea; van Reeven, Marjolein; Croome, Kristopher et al

in Journal of hepatology (2022), 76(2), 371-382

BACKGROUND: To identify the best possible outcomes in liver transplantation from donation after circulatory death donors (DCD) and to propose outcome values, which serve as reference for individual liver ... [more ▼]

BACKGROUND: To identify the best possible outcomes in liver transplantation from donation after circulatory death donors (DCD) and to propose outcome values, which serve as reference for individual liver recipients or patient groups. METHODS: Based on 2219 controlled DCD liver transplantations, collected from 17 centres in North America and Europe, we identified 1012 low-risk, primary, adult liver transplantations with a laboratory MELD of ≤20points, receiving a DCD liver with a total donor warm ischemia time of ≤30minutes and asystolic donor warm ischemia time of ≤15minutes. Clinically relevant outcomes were selected and complications were reported according to the Clavien-Dindo-Grading and the Comprehensive Complication Index (CCI). Corresponding benchmark cut-offs were based on median values of each centre, where the 75(th)-percentile was considered. RESULTS: Benchmark cases represented between 19.7% and 75% of DCD transplantations in participating centers. The one-year retransplant and mortality rate was 5.23% and 9.01%, respectively. Within the first year of follow-up, 51.1% of recipients developed at least one major complication (≥Clavien-Dindo-Grade-III). Benchmark cut-offs were ≤3days and ≤16days for ICU and hospital stay, ≤66% for severe recipient complications (≥Grade-III), ≤16.8% for ischemic cholangiopathy, and ≤38.9CCI points at one-year posttransplant. Comparisons with higher risk groups showed more complications and impaired graft survival, outside the benchmark cut-offs. Organ perfusion techniques reduced the complications to values below benchmark cut-offs, despite higher graft risk. CONCLUSIONS: Despite excellent 1-year survival, morbidity in benchmark cases remains high with more than half of recipients developing severe complications during 1-year follow-up. Benchmark cut-offs targeting morbidity parameters offer a valid tool to assess the protective value of new preservation technologies in higher risk groups, and provide a valid comparator cohort for future clinical trials. LAY SUMMARY: The best possible outcomes after liver transplantation of grafts donated after circulatory death (DCD) were defined using the concept of benchmarking. These were based on 2219 liver transplantations following controlled DCD donation in 17 centres worldwide. The following benchmark cut-offs for the most relevant outcome parameters were developed: ICU and hospital stay: ≤3 and ≤16 days; primary non function: ≤2.5%; renal replacement therapy: ≤9.6%; ischemic cholangiopathy: ≤16.8% and anastomotic strictures ≤28.4%. One-year graft loss and mortality were defined as ≤14.4% and 9.6%, respectively. Donor and recipient combinations with higher risk had significantly worse outcomes. The use of novel organ perfusion technology achieved similar, good results in this high-risk group with prolonged donor warm ischemia time, when compared to the benchmark cohort. [less ▲]

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See detailPrevention and Management of Donor-transmitted Cancer After Liver Transplantation: Guidelines From the ILTS-SETH Consensus Conference.
Domínguez-Gil, Beatriz; Moench, Kerstin; Watson, Christopher et al

in Transplantation (2022), 106(1), 12-29

As with any other intervention in health, liver transplantation (LT) entails a variety of risks, including donor-transmitted cancers (DTCs). At present, 2%-4% of used deceased organ donors are known to ... [more ▼]

As with any other intervention in health, liver transplantation (LT) entails a variety of risks, including donor-transmitted cancers (DTCs). At present, 2%-4% of used deceased organ donors are known to have a current or past history of malignancy. The frequency of DTCs is consistently reported at 3-6 cases per 10 000 solid organ transplants, with a similar frequency in the LT setting. A majority of DTCs are occult cancers unknown in the donor at the time of transplantation. Most DTCs are diagnosed within 2 y after LT and are associated with a 51% probability of survival at 2 y following diagnosis. The probability of death is greatest for DTCs that have already metastasized at the time of diagnosis. The International Liver Transplantation Society-Sociedad Española de Trasplante Hepático working group on DTC has provided guidance on how to minimize the occurrence of DTCs while avoiding the unnecessary loss of livers for transplantation both in deceased and living donor LT. The group endorses the Council of Europe classification of risk of transmission of cancer from donor to recipient (minimal, low to intermediate, high, and unacceptable), classifies a range of malignancies in the liver donor into these 4 categories, and recommends when to consider LT, mindful of the risk of DTCs, and the clinical condition of patients on the waiting list. We further provide recommendations to professionals who identify DTC events, stressing the need to immediately alert all stakeholders concerned, so a coordinated investigation and management can be initiated; decisions on retransplantation should be made on a case-by-case basis with a multidisciplinary approach. [less ▲]

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See detailFibroblast-derived prolargin is a tumor suppressor in hepatocellular carcinoma.
Chiavarina, Barbara; Ronca, Roberto; Otaka, Yukihiro et al

in Oncogene (2022)

Cancer-associated fibroblasts (CAF) are important constituents of the tumor microenvironment (TME) and are major drivers of tumorigenesis. Yet, therapies aiming at eliminating CAF have failed to cure ... [more ▼]

Cancer-associated fibroblasts (CAF) are important constituents of the tumor microenvironment (TME) and are major drivers of tumorigenesis. Yet, therapies aiming at eliminating CAF have failed to cure patients. This setback has raised questions regarding whether CAF exclusively favour cancer progression, or if they may also assume tumor-suppressor functions. In the present study, we used proteomics and single cell RNA-sequencing analysis to examine the CAF landscape in hepatocellular carcinoma (HCC). We thereby unveil three major CAF populations in HCC, one of which specifically expressing the prolargin protein. This CAF subpopulation (further termed as CAF_Port) shared a strong transcriptomic signature with portal liver fibroblasts. We further show that CAF_Port deposit prolargin in the TME and that its levels are lower in tumors as compared to the peritumoral region. Mechanistically, aggressive cancer cells degraded prolargin using matrix metalloprotease activity. Survival analysis of 188 patients revealed that high prolargin protein levels correlate with good patient outcome (HR = 0.37; p = 0.01). In vivo, co-injection of cancer cells with fibroblasts silenced for prolargin, led to faster tumor development (5-fold; p = 0.01), mainly due to stronger angiogenesis. Using protein-protein interaction study and structural modelling, we further demonstrate that prolargin binds and inhibits the activity of several pro-agiogenic proteins, including hepatocyte and fibroblast growth factors. In conclusion, prolargin is angiogenesis modulator and CAF-derived tumor suppressor in HCC. Stabilizing prolargin levels in the CAF_Port subpopulation may revert their tumor-antagonizing properties, warranting exploration in further pre-clinical studies. [less ▲]

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See detailLes éventrations péristomiales
DETRY, Olivier ULiege

in AFISCEP.be mag (2021)

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See detailFace à la COVID-19. La transplantation d’organes en période de pandémie SARS-CoV-2 : l’expérience 2020-2021 du Centre liégeois de Transplantation.
Paolucci, Maité ULiege; DELBOUILLE, Marie-Hélène ULiege; WEEKERS, Laurent ULiege et al

in Revue medicale de Liege (2021), 76(10), 719-723

The «Severe Acute Respiratory Syndrome coronavirus 2» (SARS-CoV-2) pandemic has disrupted medical care and intra-hospital organization during 2020, both in Belgium and throughout the world. Solid organ ... [more ▼]

The «Severe Acute Respiratory Syndrome coronavirus 2» (SARS-CoV-2) pandemic has disrupted medical care and intra-hospital organization during 2020, both in Belgium and throughout the world. Solid organ transplantation was not spared and in Belgium, the number of organ donors and transplants overall decreased by 20 % for livers and by 33 % for hearts between 2019 and 2020. The aim of this article is to summarize the experience acquired in 2020 and 2021 on the organizational and medical implications of the coronavirus disease 2019 (COVID-19) pandemic with regard to the care of patients transplanted or awaiting for organ transplants, and to draw conclusions both for the aftermath of COVID-19 but also for future pandemics. Vaccination against SARS-CoV-2 is highly recommended and particularly important in organ transplant recipients, even if the response rate is lower than in the non-transplanted population. A third injection is now advised in immunosuppressed patients. [less ▲]

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See detailCOVID-19 in liver transplant candidates: pretransplant and post-transplant outcomes - an ELITA/ELTR multicentre cohort study.
Belli, Luca Saverio; Duvoux, Christophe; Cortesi, Paolo Angelo et al

in Gut (2021), 70(10), 1914-1924

OBJECTIVE: Explore the impact of COVID-19 on patients on the waiting list for liver transplantation (LT) and on their post-LT course. DESIGN: Data from consecutive adult LT candidates with COVID-19 were ... [more ▼]

OBJECTIVE: Explore the impact of COVID-19 on patients on the waiting list for liver transplantation (LT) and on their post-LT course. DESIGN: Data from consecutive adult LT candidates with COVID-19 were collected across Europe in a dedicated registry and were analysed. RESULTS: From 21 February to 20 November 2020, 136 adult cases with laboratory-confirmed SARS-CoV-2 infection from 33 centres in 11 European countries were collected, with 113 having COVID-19. Thirty-seven (37/113, 32.7%) patients died after a median of 18 (10-30) days, with respiratory failure being the major cause (33/37, 89.2%). The 60-day mortality risk did not significantly change between first (35.3%, 95% CI 23.9% to 50.0%) and second (26.0%, 95% CI 16.2% to 40.2%) waves. Multivariable Cox regression analysis showed Laboratory Model for End-stage Liver Disease (Lab-MELD) score of ≥15 (Model for End-stage Liver Disease (MELD) score 15-19, HR 5.46, 95% CI 1.81 to 16.50; MELD score≥20, HR 5.24, 95% CI 1.77 to 15.55) and dyspnoea on presentation (HR 3.89, 95% CI 2.02 to 7.51) being the two negative independent factors for mortality. Twenty-six patients underwent an LT after a median time of 78.5 (IQR 44-102) days, and 25 (96%) were alive after a median follow-up of 118 days (IQR 31-170). CONCLUSIONS: Increased mortality in LT candidates with COVID-19 (32.7%), reaching 45% in those with decompensated cirrhosis (DC) and Lab-MELD score of ≥15, was observed, with no significant difference between first and second waves of the pandemic. Respiratory failure was the major cause of death. The dismal prognosis of patients with DC supports the adoption of strict preventative measures and the urgent testing of vaccination efficacy in this population. Prior SARS-CoV-2 symptomatic infection did not affect early post-transplant survival (96%). [less ▲]

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See detailLong-term outcome of liver transplantation for neuroendocrine tumour non-resectable liver metastases: a Belgian retrospective multi-centre study
Bonaccorsi-Riani, E; Cloquell, I; DETRY, Olivier ULiege et al

Conference (2021, September 16)

Liver transplantation (LT) is the only curative treatment for non-resectable liver metastases from neuroendocrine tumours (NET-Liver-mets). The adoption of strict indication criteria improves long-term ... [more ▼]

Liver transplantation (LT) is the only curative treatment for non-resectable liver metastases from neuroendocrine tumours (NET-Liver-mets). The adoption of strict indication criteria improves long-term survival. We retrospectively reviewed the medical records of all of patients who underwent LT by NET-mets at the six LT centres in Belgium from 1986 to 2020. Patient and tumour characteristics, indication for transplantation and surgical techniques, long-term survival of the patient, and tumour recurrence rate were analysed to identify prognostic factors to improve our guidelines. Forty patients underwent a LT for NET-Liver-mets in Belgium. Most patients were male (74.2%) with a mean age of 41.9 and 47.1 years at the time of NET diagnosis and liver transplantation, respectively. The location of the primary tumour was mainly the pancreas in 57.5%, followed by the small intestine in 25% of the cases, and in 84% of the patients the primary tumour was resected before LT. The post-LT overall patient survival rate at 1, 5, and 10 years are: 84,3%, 65,0% and 54,6% respectively, while the overall disease-free survival are 76,3%, 44,5% and 38.2 in the same intervals. However, the survival rate of transplant patients after 2010 at 1, 5 and 10 years is 84.2%, 74.8 and 74.8% compared to 85%, 60.0% and 49, 5% of transplanted patients before 2010. These findings suggest an improvement in the long-term survival rate for patients undergoing LT after 2010. In conclusion, our study shows that LT is a valid treatment for non-resectable liver metastasis from neuroendocrine tumours. [less ▲]

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See detailLiver grafts procured and discarded by all Belgian centers and transplanted within Eurotransplant network: analysis of cause to decline, a Be-LIAC study
Germanova, D; DELWAIDE, Jean ULiege; DETRY, Olivier ULiege et al

Conference (2021, September 16)

The annual balance between imports and exports of grafts is a matter of debate. We examined the Eurotransplant database of all liver grafts procured within Belgium and Luxemburg which were exported and ... [more ▼]

The annual balance between imports and exports of grafts is a matter of debate. We examined the Eurotransplant database of all liver grafts procured within Belgium and Luxemburg which were exported and transplanted abroad. The aim of our study was to analyse the reasons for graft refusal by all Belgian transplant centres and early postoperative evolution. Database between 2015 and 2019 included donor characteristics, reason of offer decline, graft and recipient survival. During the 4 year period 329 grafts were procured in Belgium and transplanted abroad. 163 were exported for HU recipients, 17 no national match recipients (8 AB group, 2 pediatric and 7 other reasons), 19 pay back, 15 splits, 11 not mentioned. Hundred and four grafts were declined by all Belgian centres. Forty seven were declined primary offers and fifty seven livers were distributed by extended allocation. Between them we find out four DCD donors, 83 for medical reasons (age, cytolysis, size mismatch and steatosis). Thirteen livers were accepted and declined at arrival for size mismatch (kept as rescue offer in the same centre). One donor was unstable and two were rejected for positive HCV virology. Only one liver who was primary accepted for a split was transplanted as a whole liver. Two patients presented primary graft nonfunction and three primary graft dysfunction. All of them were retransplanted. Thirteen patients died in the early 3 month postoperative period. Even though higher mortality is expected from marginal grafts, better acceptance rate could be achieved at a national level. [less ▲]

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See detailDiagnostic et traitement des kystes hépatiques.
Klein, L.; MEURISSE, Nicolas ULiege; Honoré, Pierre ULiege et al

in Revue medicale de Liege (2021), 76(9), 661-665

Cystic hepatic lesions are frequent and sometimes large. They are generally asymptomatic and discovered by chance. The differential diagnosis of these lesions includes congenital, post-traumatic, benign ... [more ▼]

Cystic hepatic lesions are frequent and sometimes large. They are generally asymptomatic and discovered by chance. The differential diagnosis of these lesions includes congenital, post-traumatic, benign or malignant tumors, as well as infectious pathologies. Conventional or contrast ultrasonography, abdominal computed tomography and magnetic resonance imaging can be used to characterize them. Therapeutic abstention with or without iconographic monitoring constitutes the optimal management of many benign liver cysts without clinical repercussions. Treatments for symptomatic or potentially aggressive lesions may include fenestration, puncture with sclerotherapy, or surgical resection. In this article, the authors discuss how to diagnose and treat the various hepatic cystic lesions. [less ▲]

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See detailLong term follow-up of liver transplant recipients after allogeneic mesenchymal stromal cell infusion
VANDERMEULEN, Morgan ULiege; Mohamed Wais, M; DELBOUILLE, Marie-Hélène ULiege et al

in Transplant International (2021, August), 34(S1 OP282), 45

Background: Some properties of mesenchymal stromal cells (MSCs) might be particularly of interest after organ transplantation. The authors aimed to report herein the long-term results of their first-in ... [more ▼]

Background: Some properties of mesenchymal stromal cells (MSCs) might be particularly of interest after organ transplantation. The authors aimed to report herein the long-term results of their first-in man, prospective, controlled, phase-1 study evaluating the safety of a single third-party MSC infusion after liver transplantation (LT). Methods: Ten liver transplant recipients under standard immunosuppression received 1.5–3 9 106/kg unrelated third-party MSCs on post-operative day 3 ! 2 and were prospectively compared to a control group of 10 liver transplant recipients. Primary endpoints were set to prospectively detect potential delayed side effects of MSC infusion, and particularly occurrence of infections and cancers. As secondary endpoints, liver graft- and patient survivals, graft rejection and function, occurrence of bile duct complications, and development of anti-HLA antibodies against liver- or MSC-donors were studied. Results: There was no difference in overall rates of infection or cancer at 5 years of follow-up between the two groups. There was also no difference in liver graft- and patient survivals, graft rejection, blood liver tests or occurrence of bile duct complications. The prevalence of de novo liver DSA related to HLA-mismatches was two times higher in the MSC group compared to the control group. Three patients of the MSC group (30%) developed at least 1 de novo HLA antibody against MSC-donor. All the de novo class II HLA antibodies against MSC were linked to a shared HLA mismatch between the liver and MSC donors and 75% of HLA class II shared-mismatches led to de novo HLA antibodies. Conclusions: This long-term follow-up confirms the safety of one single MSC infusion after LT. The potential interesting effects of MSC need to be confirmed by prospective studies. The development of anti-HLA antibodies against MSC donor should be further evaluated especially in case of shared HLAmismatchesbetween graft- and MSC-donors, despite the fact that no deleterious effect could be detected. [less ▲]

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See detailMesenchymal stromal cells combined with everolimus promote Treg expansion but do not synergize in a rat liver transplant rejection model
VANDERMEULEN, Morgan ULiege; ERPICUM, Pauline ULiege; BLETARD, Noëlla ULiege et al

in Transplant International (2021, August), 34(S1 OP519), 101

Background: Mesenchymal stromal cells (MSCs) have particular properties that can be of interest in organ transplantation, including expansion of regulatory T cells (Tregs), a key factor in graft tolerance ... [more ▼]

Background: Mesenchymal stromal cells (MSCs) have particular properties that can be of interest in organ transplantation, including expansion of regulatory T cells (Tregs), a key factor in graft tolerance induction. The immunosuppression to be associated with MSCs has not yet been defined. Additionally, the impact of the association of everolimus with MSCs on Treg expansion and on induction of liver graft tolerance has never been studied. The aim of this study was to evaluate the effects of MSCs combined, or not, with everolimus, on Treg expansion and in a model of liver transplantation (LT) rejection in the rat. Methods: Firstly, Lewis rats received intravenous MSCs at D9 with/without subcutaneous everolimus from D0 to D14. Analysis of circulating Tregs was performed at D0, D14 and D28. Secondly, 48 h after LT with a Dark Agouti rat liver, 30 Lewis rats were randomized in 3 groups: everolimus (subcutaneous for 14 days), MSCs (intravenous injection at D2 and D9), or both everolimus and MSCs. Rejection of the liver graft was assessed by liver tests, histology and survival. Results: Individually, MSC infusion and everolimus promoted Treg expansion in rats, and everolimus had no negative impact on Treg expansion when combined with MSCs. However, in the LT model, injections of MSCs 2 and 9 days following LT were not effective at preventing acute rejection, and the combination of MSCs with everolimus failed to show any synergistic effect when compared to everolimus alone. Conclusion: Everolimus may be used in association with MSCs. However, in our model of LT in the rat, post-transplant MSC injections did not prevent acute rejection, and the association of MSCs with everolimus did not show any synergistic effect. [less ▲]

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See detailPerioperative risk factors of acute kidney injury post liver transplantation: a monocentric retrospective cohort study of 260 patients
Malisoux, Clarisse ULiege; KOCH, Jean-Noël ULiege; MEURISSE, Nicolas ULiege et al

in Transplant International (2021, August), 34(S1 POS315), 312

Aims and Background: Acute kidney injury (AKI) is a major risk factor of poor outcomes after liver transplantation (LT). AKI is usually attributed to post-LT events and drug toxicity. Peri-operative risk ... [more ▼]

Aims and Background: Acute kidney injury (AKI) is a major risk factor of poor outcomes after liver transplantation (LT). AKI is usually attributed to post-LT events and drug toxicity. Peri-operative risk factors of LT-associated AKI remain poorly documented, which hampers the development of personalized preventive strategies. Methods: AKI was assessed by KDIGO criteria based on creatinine changes from baseline to day 5 post LT. 260 single first full-size LTs without any pre-existing renal replacement therapy (RRT) were performed from 2003 to 2018. Incidence of AKI was assessed. Logistic regression determined the risk factors of KDIGO I and II-III AKI. Results: Incidence of AKI KDIGO I and II-III was 30% (78/260) and 25.7% (67/260), respectively. Preoperatively, patients with AKI had higher lab- MELD and Child-Pugh scores, lower serum fibrinogen and albumin levels. Donor type, donor hepatectomy and cold ischemic time were similar between groups. AKI was more frequent in case of marginal donors. LT surgery was longer in the AKI groups. Needs for per-operative blood transfusions were higher in the AKI groups. Rate of post-reperfusion syndrome was higher in AKI groups. Postoperatively, lower hemoglobin levels and higher INR from day 1-5 were associated with AKI. Peak of transaminases were not different between AKI versus non-AKI groups. AKI was associated with longer length of hospital and ICU stays. After multivariate analysis, blood transfusions and post-reperfusion syndrome were risk factors to develop KDIGO I AKI. Pre-operative serum levels of fibrinogen and albumin were risk factors for KDIGO II-III AKI. Finally, “marginal donors” was the only risk factor for both KDIGO I and II-III AKI. Conclusions: LT-associated AKI occurs in >50% of cases. Per-operative hemorrhage and post-operative reperfusion syndrome represent risk factors, particularly in cases of marginal donors. [less ▲]

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See detailCOVID-19 in liver transplant candidates: wait-list outcomes and post-transplant course
Perricone, G; Duvoux, C; Mazzarelli, C et al

in Transplant International (2021, August), 34(S1 OP232), 41

Background: The impact of prior SARS-CoV-2 infection on patients on the waiting list for liver transplantation (LT) and on their post-LT course is presently unknown. Methods: Data from adult LT candidates ... [more ▼]

Background: The impact of prior SARS-CoV-2 infection on patients on the waiting list for liver transplantation (LT) and on their post-LT course is presently unknown. Methods: Data from adult LT candidates with laboratory confirmed SARSCoV- 2 infection was collected across Europe and all consecutive patients with symptomatic COVID-19 were included in the analysis. Results: From February 21st to November 20th, 2020, 136 adult cases with laboratory-confirmed SARS-CoV-2 infection from 33 centers in 10 European countries were collected, with 113 having symptomatic COVID-19. Thirtythree (29.2%) were managed as outpatients, 80 (70.8%) required hospitalization including admission to the intensive care unit (28/80, 35%). Thirtyseven (37/113, 32.7%) patients died after a median of 18 (10-30) days, respiratory failure being the major cause (33/37, 89.2%). The 60-day mortality risk did not change between first (35.3%, 95% CI 23.9-50.0) and second wave (26.0%, 95% CI 16.2-40.2). Multivariable Cox regression analysis showed MELD score !15 (MELD15-19:HR 6.09 95%CI 2.01-18.44; MELD ! 20:HR 5.21, 95%CI 1.76-15.45) and dyspnea on presentation (HR:4.1, 95%CI 2.09-8.06) being the two negative independent factors for mortality. Twenty-six patient received a LT after a median time of 78.5 (IQR:44-102) days and 25 are alive after a median follow-up of 118 days (IQR:31-170). Conclusions: Mortality of LT candidates with symptomatic COVID-19 was high (32.7%) peaking at 45% in decompensated cirrhotic with MELD > 15 and did not significantly differ between the 2 waves of the pandemic, respiratory failure being the major cause of death thus supporting high priority for vaccination. Prior SARS-CoV-2 infection did not affect early post-transplant survival (96%). ª [less ▲]

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See detailEarly Allograft Dysfunction and Complications in DCD Liver Transplantation: Expert Consensus Statements From the International Liver Transplantation Society.
Quintini, Cristiano; Muiesan, Paolo; Detry, Olivier ULiege et al

in Transplantation (2021), 105(8), 1643-1652

Livers for transplantation from donation after circulatory death donors are relatively more prone to early and ongoing alterations in graft function that might ultimately lead to graft loss and even ... [more ▼]

Livers for transplantation from donation after circulatory death donors are relatively more prone to early and ongoing alterations in graft function that might ultimately lead to graft loss and even patient death. In consideration of this fact, this working group of the International Liver Transplantation Society has performed a critical evaluation of the medical literature to create a set of statements regarding the assessment of early allograft function/dysfunction and complications arising in the setting of donation after circulatory death liver transplantation. [less ▲]

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See detailTransplantation hépatique pour syndrome hépatopulmonaire compliquant une cirrhose.
LAPAILLE, Louis ULiege; Demoulin, AS; HEINEN, Vincent ULiege et al

in Revue medicale de Liege (2021), 76(7-8), 601-607

Le syndrome hépatopulmonaire est une complication vasculaire pulmonaire de la cirrhose relativement fréquente et sous-diagnostiquée, caractérisée par des vasodilatations capillaires et pré-capillaires ... [more ▼]

Le syndrome hépatopulmonaire est une complication vasculaire pulmonaire de la cirrhose relativement fréquente et sous-diagnostiquée, caractérisée par des vasodilatations capillaires et pré-capillaires intrapulmonaires pouvant entraîner une hypoxémie sévère. Souvent asymptomatique, ce syndrome se révèle le plus souvent par une dyspnée d’apparition progressive. Le diagnostic est réalisé par une gazométrie artérielle prouvant l’hypoxémie et une échographie cardiaque de contraste démontrant l’existence de vasodilatations intrapulmonaires. Le dépistage du syndrome hépatopulmonaire est préconisé chez tout patient atteint de cirrhose présentant de la dyspnée et chez tout patient candidat à une greffe hépatique. En effet, le seul traitement efficace est la transplantation hépatique, et ces patients bénéficient d’ailleurs de points d’exception dans le calcul du score de MELD («Model for End-Stage Liver Disease»). Nous rapportons ici le cas d’un patient de 39 ans atteint d’une cirrhose d’origine indéterminée compliquée d’un syndrome hépatopulmonaire qui s’est révélé par une dyspnée devenue rapidement invalidante. Ce patient a pu bénéficier d’une transplantation hépatique un an après le diagnostic de syndrome hépatopulmonaire, permettant ainsi une guérison complète tant sur plan hépatique que pulmonaire. [less ▲]

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See detailCholangite obstructive chez un patient atteint d’une hydatidose.
Basbous, C; Hayette, Marie-Pierre ULiege; LEONARD, Philippe ULiege et al

in Revue medicale de Liege (2021), 76(7-8), 575-578

The authors report the case of a 41-year-old patient originating from Algeria who developed obstructive cholangitis caused by the membrane of a ruptured hydatid cyst leading to the diagnosis of cystic ... [more ▼]

The authors report the case of a 41-year-old patient originating from Algeria who developed obstructive cholangitis caused by the membrane of a ruptured hydatid cyst leading to the diagnosis of cystic echinococcosis. Cystic echinococcosis can be asymptomatic for several years until a complication occurs, such as in this case an obstruction of the common bile duct, or cholangio-hydatidosis. This cause of jaundice is uncommon in Western Europe whereas it is more frequent in endemic areas. Identification and treatment of ruptured cysts are mandatory because of the mortality rate of these complications if left untreated. In this particular case, the treatment by endoscopic retrograde cholangiopancreatography was successful. [less ▲]

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See detailL'utilisation d'une sangle abdominale après chirurgie abdominale par laparotomie
Detry, Olivier ULiege

in Afiscep.bemag (2021), 31

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See detailPrise en charge multidisciplinaire des tumeurs malignes primitives du foie.
Detry, Olivier ULiege; Troisfontaine, Florence ULiege; MEURISSE, Nicolas ULiege et al

in Revue medicale de Liege (2021), 76(5-6), 519-524

In Belgium and around the world, the incidence of primary malignant liver tumours is increasing, both for hepatocarcinoma and cholangiocarcinoma. Their curative treatment is based on multidisciplinary and ... [more ▼]

In Belgium and around the world, the incidence of primary malignant liver tumours is increasing, both for hepatocarcinoma and cholangiocarcinoma. Their curative treatment is based on multidisciplinary and specialized care, of which surgery (including liver transplantation) remains the cornerstone, often associated with other logoregional treatments, as radioembolisation, radiofrequency ablation, and chemoembolisation. For advanced cases, the prognosis remains poor, in particular due to a certain chemoresistance of these tumours. New treatments include targeted therapies (including various tyrosine kinase inhibitors) and immunotherapy. A specialized multidisciplinary discussion is therefore necessary to define the best therapeutic management, individualized to each patient. In this article, the authors review the most recent data relating to the treatment of hepatocarcinoma and cholangiocarcinoma. [less ▲]

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See detailProtective role of tacrolimus, deleterious role of age and comorbidities in liver transplant recipients with Covid-19: results from the ELITA/ELTR multi-center European study.
Belli, Luca S.; Fondevila, Constantino; Cortesi, Paolo A. et al

in Gastroenterology (2021), 160(4), 1151-1163

Despite concerns that liver transplant (LT) recipients may be at increased risk of unfavorable outcomes from COVID-19 due the high prevalence of co-morbidities, immunosuppression and ageing, a detailed ... [more ▼]

Despite concerns that liver transplant (LT) recipients may be at increased risk of unfavorable outcomes from COVID-19 due the high prevalence of co-morbidities, immunosuppression and ageing, a detailed analysis of their effects in large studies is lacking METHODS: Data from adult LT recipients with laboratory confirmed SARS-CoV2 infection were collected across Europe. All consecutive patients with symptoms were included in the analysis, RESULTS: Between March 1st and June 27(th)2020, data from 243 adult symptomatic cases from 36 centers and 9 countries were collected. Thirty-nine (16%) were managed as outpatients while 204 (84%) required hospitalization including admission to the ICU (39/204, 19.1%). Forty-nine (20.2%) patients died after a median of 13.5 (10-23) days, respiratory failure was the major cause. After multivariable Cox regression analysis, age > 70 (HR 4.16; 95%CI 1.78-9.73) had a negative effect and tacrolimus (TAC) use (HR 0.55; 95%CI 0.31-0.99) had a positive independent effect on survival. The role of co-morbidities was strongly influenced by the dominant effect of age where comorbidities increased with the increasing age of the recipients. In a second model excluding age, both diabetes (HR 1.95; 95%CI 1.06 - 3.58) and chronic kidney disease (HR 1.97; 95%CI 1.05 - 3.67) emerged as associated with death CONCLUSIONS: Twenty-five per cent of patients requiring hospitalization for Covid-19 died, the risk being higher in patients older than 70 and with medical co-morbidities, such as impaired renal function and diabetes. Conversely, the use of TAC was associated with a better survival thus encouraging clinicians to keep TAC at the usual dose. [less ▲]

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See detailImmunosuppression Withdrawal After Liver Transplantation for Common Variable Immunodeficiency.
Detry, Olivier ULiege; MEURISSE, Nicolas ULiege; Jouret, François ULiege et al

in Liver Transplantation (2021), 27(3), 456-458

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